Capsule endoscopy: screening the bowel

Written by: Professor Owen Epstein
Published: | Updated: 27/01/2020
Edited by: Emma McLeod

The capsule endoscopy is an example of what wireless technology can achieve. With a simple capsule, some water and a monitor, you can have all 26 feet of your digestive tract screened. Professor Owen Epstein explains how this miniature technological marvel has altered the scope of colonoscopy screening.


A women is holding a clear glass of water to her lips. In order to begin the capsule endoscopy, she simply needs to consume the capsule with water.

The importance of colonoscopies

Patients opting for a screening of the digestive tract are usually referred to have a colonoscopy, which is a type of endoscopy. Colonoscopy screening programs are used to detect cancer, which is uncommon, and polyps. Most polyps that are discovered are small, benign and unlikely to progress. Nevertheless, the detection of these is one of the few ways colon cancer can be prevented.


“Issues” with traditional colonoscopies

Whilst a traditional colonoscopy is an excellent screening test of the five feet of the large intestine and offers the opportunity to remove suspected polyps, the procedure does contain some shortcomings due to its long tube and connectivity to a monitor.

  • The procedure is invasive
  • It can be uncomfortable
  • It requires a day case admission into hospital
  • It can require intravenous analgia (pain medication that is inserted into a vein), sedation or anaesthesia
  • It is occasionally complicated by perforation (1 in every 1000)
  • The test does not provide images of the oesophagus, stomach, or small intestine, all of which are subject to disease


Despite these, it is important to remember that traditional colonoscopies do have their benefits, particularly regarding the ability to remove polyps upon diagnosis and treating other conditions.


What is a capsule colonoscopy

A capsule colonoscopy is an alternative screening test for healthy individuals considering colon screening. The capsule endoscope is a TV studio in a “pill” that is swallowed by a patient and their natural bowel movements power the pill’s passage through 26 feet of the digestive tract (mouth to rectum). The pill will travel in the exact same way as food or drink. Whilst the capsule travels through the digestive tract, it relays a wireless video feed of the surface of the oesophagus, stomach, small and large intestine (colon). This minimally invasive scouting test screens for abnormalities throughout the entire 26 feet of the digestive organ.


But how can a specialist see the results?

After the disposable capsule is passed through the body naturally, the images are downloaded from a small receiver that is worn by the patient. They are then reviewed on a computer screen. No need for wires or a physical connection to a computer while the digestive tract is surveyed.


Benefits of a capsule colonoscopy

  • There is no need for hospital admission, sedation or pain relief medication
  • There is no risk of perforation
  • The test is completed at home


What if something is discovered?

In a small minority of patients, the screening test will discover a significant abnormality requiring further intervention to address it. A traditional endoscope can be used to perform a biopsy, remove polyps and/or to treat bleeding.


When the specialist considers it appropriate, the minimally invasive wireless capsule can be used to first look at the abnormality and, if necessary, a traditional endoscope is then used to address the issue. In short, both can be used in harmony to treat a patient.


Get in touch with Professor Epstein by booking an appointment via his profile.

By Professor Owen Epstein

Professor Owen Epstein is a renowned and pioneering professor of gastroenterology, based at the Royal Free Hospital in Hampstead, London. He has a special interest in the innovation of healthcare and the technologies used to ease the patient journey. These include whole bowel wireless capsule (pill) endoscopy and hydrogen or 13C breath testing variously for lactose intolerance, small intestinal bacterial overgrowth, Helicobacter pylori, and stomach pump function. He also has considerable experience in the physiological assessment of the vagus nerve and stress and, in particular, its relationship to abnormal gut feelings. Professor Epstein has had a hugely successful career and is regarded as one of the leaders in minimally-invasive techniques and a gentler patient journey.

Professor Epstein is widely published with more than 100 reviewed publications to his name. He is the senior author of the best-selling textbook Clinical Examination and the originator of the 'The Map  of Medicine', which is a key online resource used by healthcare professionals. He founded the Royal Free Screen Based Simulation Centre, where medical and surgical gastroenterologists use virtual reality to acquire mastery of endoscopy and laparoscopic surgery prior to engaging in live procedures. More recently, Professor Epstein has introduced new and minimally-invasive assessment tools and founded a new 'Institute for Minimally Invasive Gastroenterology (IMIGe)' at the Royal Free. He is director of the IMIGe Academy for Capsule Endoscopy which teaches aspiring capsule practitioners. Professor Epstein is award-winning and, over the years, has received research grants amounting to more than £1 million. He has contributed hugely to new medical technologies that change the patient's journey, and continues to do so.

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